State Members

Medical Plans

Overview

Selecting the right medical plan is an important decision; one that can impact your finances. It’s important to consider how the plans are similar, where they differ in cost, and which one is the right fit for you.

Family Roll Up

Two married active state employees who cover children may combine medical and prescription deductibles and out of pocket maximums by participating in Family Roll Up. This offering allows subscribers to combine their deductibles into one family deductible. For example, one spouse covers themselves and their children on a family plan, while the other spouse covers only themselves on an individual plan. With a Family Roll Up, this family would only have to meet one family deductible and one family out of pocket maximum in a calendar year.

To participate, each spouse must enroll in the same medical plan through the same carrier. Each spouse must report they are married to an active state employee eligible for MCHCP medical benefits and provide the spouse’s Social Security number (SSN) during the Open Enrollment process, or by completing section 5 on the Enroll/Change/Cancel form.

When using Family Roll Up:

The spouse who covers the dependent children is considered the subscriber (policy holder) for the entire family

The spouse not covering the children is considered a dependent on the policy and is listed as a dependent on the ID cards

When contacting the medical or prescription plan’s customer service department, the dependent spouse should provide the subscribing spouse’s SSN or other identifying information in order to receive coverage and claim information

The dependent spouse should present the correct ID card to providers for proper claims submission under the correct policy. If the correct ID card is not used, it could delay claim submission and/or processing.

All three of MCHCP’s medical plans offer the same, basic coverage, such as:

Preventive care — such as annual wellness exams, vaccinations and age-specific screenings — covered 100 percent, when received from a network provider.

Freedom to choose care from a nationwide network of primary care providers, specialists, pharmacies and hospitals, usually at a lower negotiated group discount.

The same covered benefits for both medical and pharmacy.

However, while the benefits are the same in all three plans, other aspects differ — such as the premium, deductible and out-of-pocket (OOP) costs.

The member pays the deductible, copayments and coinsurance amounts until the OOP maximum is reached. There are separate deductibles and OOP maximums for network and non-network services.

HSA Plan

The HSA Plan is a qualified high-deductible plan. Members receive health coverage at a lower or no-cost premium, when compared to other MCHCP medical plans.

* Reduced coinsurance/copayments for certain diabetic medications and supplies. See Prescription Drug Plans for more information.

HSA vs FSA

Active employees are encouraged to fund their medical expenses by setting up either a Health Savings Account (HSA) or a health care Flexible Spending Account (FSA). Both accounts allow members to deposit and withdraw money tax-free for qualified medical expenses.

FSA - Contributions are taken from paycheck on a pre-tax basis (before taxes are withheld). Claim reimbursements for qualified medical expenses are tax-free.

Contribution rules for HSAs are complex. Members should consult a tax advisor about individual circumstances and the maximum annual contribution. MCHCP does not provide individual tax advice.

Transitioning from an FSA to an HSA
Subscribers cannot be in a health care FSA and be eligible for an HSA at the same time. Subscribers may, however, participate in the HSA and a Dental/Vision Health Care FSA.

In order to receive HSA contributions from MCHCP, a subscriber’s health care FSA must first have a zero balance. Subscribers with a remaining balance in their FSA on December 31 will wait longer to receive their HSA contribution the following year. Subscribers have until April 15 (the following year) to claim expenses through their FSA. MCHCP will make its annual contribution to the HSA in April rather than in January. If a subscriber does not have an outstanding balance in their health care FSA on December 31, MCHCP will make its annual contribution in January.

Deadlines to remember

Date

Description

December 31

FSA must have a zero balance in order to receive the MCHCP HSA contribution in January

January

MCHCP contribution will be deposited into HSA if FSA has a zero balance on December 31

March 15

Date of service deadline for any FSA remaining funds to be used for qualified expenses. Funds that are not used by this date will be forfeited

April

MCHCP contribution will be deposited into HSA if there were remaining FSA funds on December 31

April 15

Deadline to submit claims for remaining FSA funds used by March 15th. Funds that are not claimed by this date will be forfeited

Annual Contribution Limits

2017

2017

Contributions

Subscriber Only

Subscriber/Spouse
Subscriber/Child(ren)
Subscriber/Family

IRS Contribution Limit

Subscriber Only: $3,400

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $6,750

IRS Contribution Limit
(age 55 and older)

Subscriber Only: $4,400

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $7,750

MCHCP Contribution
(active employee subscribers only)

Subscriber Only: $300

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $600

Active subscribers may contribute

Subscriber Only: $3,100

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $6,150

Active subscribers may contribute
(age 55 and older)

Subscriber Only: $4,100

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $7,150

2018

2018

Contributions

Subscriber Only

Subscriber/Spouse
Subscriber/Child(ren)
Subscriber/Family

IRS Contribution Limit

Subscriber Only: $3,450

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $6,900

IRS Contribution Limit
(age 55 and older)

Subscriber Only: $4,450

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $7,900

MCHCP Contribution
(active employee subscribers only)

Subscriber Only: $300

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $600

Active subscribers may contribute

Subscriber Only: $3,150

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $6,300

Active subscribers may contribute
(age 55 and older)

Subscriber Only: $4,150

Subscriber/Spouse, Subscriber/Child(ren), Subscriber/Family: $7,300

Contribution rules for HSAs are complex. Members should consult a tax advisor about individual circumstances and the maximum annual contribution. MCHCP does not provide individual tax advice.

Control: HSA funds accumulate to pay for IRS-qualified medical expenses, such as doctor and chiropractor fees, dental treatments, hospital bills, prescriptions and more. You decide how to spend it based on your health care needs and budget. Plus, HSA funds roll over from year to year, there is no "use-it-or-lose-it" policy.

Flexibility: You can deposit (as long as you remain eligible) or withdraw money any time. There is a yearly maximum amount for how much you can put in your account.

Portability: You own the HSA funds and may keep them — even if you later change plans, leave your job or retire.

Tax Savings: There are triple tax savings with an HSA

You can put away money for qualified medical expenses before taxes are taken out. This means you set aside income-tax-free dollars in an HSA to pay for qualified medical expenses.

Savings in your HSA grow tax-free.

You pay no taxes when you use HSA funds to pay for qualified medical expenses.

MCHCP Contribution: MCHCP will contribute to the HSAs of active employees — $300 for individual coverage and $600 for family coverage. New employees or subscribers who elect coverage during a special enrollment period with an effective date after January 1 will receive a prorated contribution.

Qualified expenses include doctor and chiropractor fees, dental treatments, hospital bills and prescriptions. A complete list of qualified expenses can be found on the IRS website. HSA funds may also be used toward the qualified medical expenses of the subscriber's spouse and eligible dependents (as defined by the IRS).

Have received medical benefits from the Department of Veterans Affairs (VA) at any time during the previous three (3) months, unless the medical benefits received consist solely of disregarded coverage or preventive care.

Active employee opens an HSA through Central Bank. The bank will send a debit card, along with detailed information about the account.

Members may contribute to their HSA any time. MCHCP will make an annual contribution to each active employee’s HSA. Members are also encouraged to fund their account up to the annual limit set by the IRS (see Annual Contribution Limits). Active employees may contribute through voluntary payroll deductions. Retirees may contribute by making deposits directly with Central Bank.

When visiting any health care provider or pharmacy, the member may pay for their expenses using the HSA debit card. No claim forms are required.

There are no copayments with the HSA Plan. Members will pay all of their medical and prescription expenses, using their HSA funds or out of their pocket, until the annual deductible is met. The HSA may be used at any time for qualified expenses, as long as sufficient funds are available in the account.

Once the deductible is met, members will pay coinsurance on covered expenses until their out-of-pocket maximum is reached. At that time, the plan will begin paying 100 percent of covered services.

When a subscriber enrolls in Medicare and is no longer eligible to participate in the HSA Plan, remaining HSA funds may still be used for qualified medical expenses.

Members under 65 can use the account to pay deductibles, copayments and coinsurance. If the funds are used for non-qualified medical expenses, the member will be required to pay taxes on those funds, as well as an associated penalty.

Members 65 or older can use the account to pay Medicare or MCHCP premiums, deductibles, copayments and coinsurance. The account cannot be used to pay for Medicare Supplement insurance or a "Medigap" policy.

If two or more family members are covered in the HSA Plan, the family deductible must be met before the member begins paying applicable coinsurance. One covered family member's expenses may meet the entire family deductible.

The maximum annual MCHCP contribution for married state employees who cover children when both are enrolled in the HSA Plan is $600. Each spouse will receive $300 into their individual health savings account.

Emergency Room Copayment
Members visiting an emergency room (ER) may pay a $100 copayment. This copayment is waived if the member is admitted to the hospital or the services are considered by the medical plan to be a "true emergency." Even if the copayment is waived, the member will still have to pay any deductible or coinsurance owed for the ER service.

Copayments apply to the out-of-pocket maximum, but not the deductible. Medicare retirees will not owe copayments; they are only charged coinsurance.

How the PPO 600 Plan Works

When visiting a health care provider, the member will pay for their medical expenses out of their pocket until the annual deductible is met. Members visiting an emergency room may also pay a $100 copayment.

Once the deductible is met, members will pay coinsurance on covered expenses until their out-of-pocket maximum is reached. At that time, the plan will begin paying 100 percent of covered services.

Family Coverage
If two or more family members are covered in a PPO plan and one family member reaches the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the individual. If one or more additional family members meet the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the entire family.

The office visit copayments cover the visit only. Any lab, X-ray or other services associated with the visit will apply to the deductible and coinsurance.

Chiropractor copayment may be less than $20 if it is more than 50 percent of the total cost of the service.

Copayments
Members will pay a copayment for office visits, urgent care and emergency room (ER) services. The ER copayment is waived if the member is admitted to the hospital or the services are considered by the medical plan to be a "true emergency." Even if the copayment is waived, the member will still have to pay any deductible or coinsurance owed for the ER service.

Copayments apply to the out-of-pocket maximum, but not the deductible. Medicare retirees will not owe copayments; they are only charged coinsurance.

How the PPO 300 Plan Works

When visiting a health care provider, the member will pay a copayment for each visit. The member will also pay for other medical expenses out of their pocket until the annual deductible is met.

Once the deductible is met, members will continue to pay copayments. However, members will now pay coinsurance on covered expenses until their out-of-pocket maximum is reached. At that time, the plan will begin paying 100 percent of covered services.

Family Coverage
If two or more family members are covered in a PPO plan and one family member reaches the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the individual. If one or more additional family members meet the individual deductible or out-of-pocket maximum, the medical plan begins paying claims for the entire family.

Non-Contraception Benefit Option

Missouri state law, Section 191.724, RSMo, allows a person the right to decline or refuse coverage for contraception if these items or procedures are contrary to an employee’s religious beliefs or moral convictions.

While all MCHCP plans cover these services (see Contraception and Sterilization), if you have such a religious or moral conviction, MCHCP is offering a benefit plan option excluding these services. If you declare you have a religious or moral objection, your benefits will provide no coverage for contraception as either a medical or pharmacy benefit for non-Medicare primary individuals covered on your plan.

MCHCP is not able to alter contraception benefits for those with Medicare primary coverage. The U.S. Department of Health and Human Services makes the rules for Medicare and includes contraception benefits in Medicare.

All MCHCP non-Medicare primary subscribers have the option to declare a religious or moral objection and decline contraception coverage.

Members may log into their myMCHCP account to select the non-contraception benefit option. Members may also contact MCHCP Member Services at 800-487-0771 with questions or to request a non-contraception benefit option form to fill out.

TRICARE Supplement Plan

Military Members Only

Military members can choose the TRICARE Supplement Plan, administered by Selman & Company, instead of MCHCP medical and pharmacy benefits. The TRICARE Supplement Plan works with TRICARE, the Department of Defense’s health benefit program for the military community.

To be eligible, the member must be a non-Medicare active state employee, retiree, terminated vested subscriber or survivor and have TRICARE.

Features include:

Fully employee paid by pre-tax dollars through payroll deduction

No deductibles

No pre-existing condition limitations

No copayments or coinsurance

Ability to use civilian physicians

A copy of subscriber's military ID is required to enroll in the TRICARE Supplement Plan. Enrolled subscribers may enroll eligible dependents in the plan. Dependent military IDs must also be submitted, if issued.

For more information about the plan and to determine eligibility, contact Selman & Company.